PROJECT SUMMARY/ABSTRACT Over 46,000 people died from opioid overdose in 2018 and an additional 11.4 million abused prescription opioids. This led to the declaration of a national public health emergency to address the opioid crisis. Excess opioid prescribing by healthcare providers, including surgeons, has played a major role in the current epidemic. Interventions targeting opioid prescribing in surgical populations have had only modest results, with none of these specifically designed for rural surgical patients. Rural health disparities compound the complexity of the opioid epidemic for rural surgical patients, necessitating the development of novel interventions in this population. This project will characterize unique factors contributing to excess opioid prescribing in rural surgical patients and adapt a multifaceted intervention to decrease excess prescribing. The project proposes the following aims: 1) Identify patient, surgeon and system factors associated with opioid prescribing following surgery in rural settings, 2) Characterize surgeon and patient perceptions of factors associated with perioperative opioid prescribing among rural surgeons, and 3) Adapt and pilot-test a behavioral intervention to improve opioid stewardship in rural surgeons. Through mentored research and career development activities, Dr. Borza will prepare for a career as an independent health services researcher focused on improving quality of care in rural surgery through the development, evaluation and dissemination of tailored interventions and research informing surgical quality, practice patterns and policy evaluations. He will acquire expertise in 1) performance measurement in rural surgery, 2) qualitative design and analysis, 3) intervention design and development, and 4) responsible conduct of research. As a surgeon with a Master’s degree in Healthcare Research, Dr. Borza is uniquely qualified to conduct this work. This proposal addresses educational and career development gaps critical to securing independent funding through a multidisciplinary mentored program with experts in performance measurement, rural health, substance abuse, qualitative research, intervention design and development and quality improvement through surgical collaboratives. He is supported by the robust research infrastructure at the University of Wisconsin, where the Department of Urology ranks twelfth in National Institutes of Health funding, the Department of Surgery Wisconsin Surgical Outcomes Research Program promotes the collaboration and success of health services researchers and the Surgical Collaborative of Wisconsin offers a well-established, engaged network of surgeons. In addressing excess opioid prescribing by rural surgeons, this award meets an urgent public health need in an underserved population while affording the education and mentored research experience critical for Dr. Borza’s development into a national leader on rural surgical quality and independent health servi...